A nurse is caring for a client who is receiving peritoneal dialysis and notes a decrease in the dialysate flow rate. Which of the following actions should the nurse take? (Select all that apply)
Raise the drainage bag above the level of the client’s abdomen
Elevate the client to the high-Fowler’s position
Measure the amount of the dialysate outflow
Monitor the access site for drainage
Reposition the client onto the other side
Correct Answer : C,D,E
Choice A reason: Raising the drainage bag above the abdomen reverses gravity flow, stopping dialysate outflow and worsening the issue in peritoneal dialysis. Fluid drains downward naturally, so elevating the bag traps it, potentially causing discomfort or infection risk from stagnation. This action opposes dialysis mechanics, where the bag must stay low, making it contraindicated and detrimental to treatment efficacy.
Choice B reason: High-Fowler’s position (upright) may shift abdominal contents, but it doesn’t directly resolve catheter blockages or flow issues in peritoneal dialysis. It’s used during infusion to aid breathing, not drainage. Without evidence of respiratory distress, this adjustment lacks priority over actions addressing flow directly, like repositioning, rendering it less effective here.
Choice C reason: Measuring dialysate outflow quantifies the flow reduction, identifying if less fluid returns than infused, signaling obstruction or leakage. This data guides interventions, like catheter checks or flushes, ensuring dialysis removes toxins effectively. It’s a critical step in troubleshooting, providing objective evidence of the problem’s scope, essential for maintaining treatment goals.
Choice D reason: Monitoring the access site for drainage detects leaks or infection—common flow rate culprits—as fluid escaping reduces outflow. Peritonitis risk rises with poor site integrity, necessitating early intervention. This action ensures catheter function and patient safety, directly addressing potential causes of the observed decrease, making it vital.
Choice E reason: Repositioning to the other side relieves catheter kinks or omental wrapping, frequent causes of slow flow in peritoneal dialysis. Shifting position adjusts intra-abdominal pressure, freeing the catheter tip to drain properly. This non-invasive fix restores dialysis efficacy, a standard first-line response, directly tackling mechanical flow issues effectively.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Infusing 0.9% sodium chloride at 150 mL/hr through an arterial line is excessive and dangerous, risking fluid overload or vessel damage. Arterial lines use a slow flush (1-3 mL/hr) to maintain patency, not high-volume infusion. This rate suits IV hydration, not arterial monitoring, making it an incorrect and harmful action for this setup.
Choice B reason: Having the client bear down (Valsalva maneuver) increases intrathoracic pressure, falsely elevating arterial readings, distorting accuracy. Arterial lines provide continuous, real-time pressure via transducers, not manual checks requiring such actions. This technique applies to venous lines or respiratory tests, not arterial monitoring, rendering it inappropriate and misleading here.
Choice C reason: Maintaining the pressure bag at 300 mm Hg ensures a continuous flush (1-3 mL/hr) of saline, preventing clot formation in the arterial line, which could block it. This pressure exceeds arterial systolic values, keeping the system patent and readings accurate. It’s a standard practice, critical for reliable monitoring, making it the correct action in this scenario.
Choice D reason: Aligning the transducer to the radial artery level is incorrect; it should be at the phlebostatic axis (heart level) for accurate pressure readings. Radial alignment overestimates pressure due to gravitational effects, skewing data. Proper calibration at the heart ensures true arterial values, so this action fails to meet monitoring standards.
Correct Answer is A
Explanation
Choice A reason: Omega-3 fish oil, rich in EPA and DHA, lowers triglycerides by reducing hepatic VLDL production and enhances LDL clearance, cutting cholesterol levels. Clinical studies show it decreases cardiovascular risk in hyperlipidemia. For a client with high cholesterol, this supplement directly targets lipid metabolism, offering a therapeutic benefit, making it the appropriate choice here.
Choice B reason: Glucosamine, derived from shellfish, supports cartilage repair in osteoarthritis by aiding glycosaminoglycan synthesis, not affecting cholesterol pathways. It lacks lipid-lowering properties, focusing on joint health instead. For a client with high cholesterol, this supplement offers no benefit to lipid profiles, rendering it irrelevant to the goal of reducing levels.
Choice C reason: Cranberry tablets inhibit bacterial adhesion in the urinary tract, preventing infections, but have no impact on cholesterol metabolism or lipid levels. Their anthocyanins benefit bladder health, not cardiovascular risk factors. In high cholesterol, this supplement doesn’t address the condition, making it an ineffective choice for this client’s needs.
Choice D reason: Ginkgo biloba enhances cerebral blood flow via vasodilation, potentially aiding memory, but it doesn’t alter cholesterol synthesis or clearance. Its antioxidants target circulation, not lipids directly. For a client with high cholesterol, this supplement lacks evidence of lowering levels, failing to meet the therapeutic aim here.
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